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Lateral Toe Pulp Flap Used in Reconstruction of Distal Dorsal Toe Defect

Case Report and Review of the Literature

Cheng, Li-Fu, MD; Lee, Jiunn-Tat, MD; Wu, Meng-Si, MD

doi: 10.1097/SAP.0000000000001703
Reconstructive Surgery
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SDC

Background When the distal dorsal part of the great toe is injured, especially with exposure of a tendon, bone, or joint, applying a free or local flap is difficult because of the lack of locally available tissue for reconstruction. Management of the distal dorsal part of a great toe soft tissue defect can be challenging for plastic surgeons.

Patient and Method An 18-year-old woman presented with an injury to the dorsal aspect of her right great toe caused by a cobra bite. After fasciotomy, the wound showed exposure of the extensor hallucis longus tendon. After demarcation and infection control, the wound was reconstructed using a lateral toe pulp flap of approximately 3.5 × 1.0 cm2. The flap was transposed to the defect, and the donor site was closed primarily. Toe pulp flaps are mainly used to reconstruct finger pulp defects and are useful because they provide a glabrous skin flap suitable for resurfacing fingertip injuries. A lateral toe pulp flap uses a homodigital adjacent skin flap, which is transposed to cover the soft tissue defect. Using a quick and straightforward procedure, we designed this flap to reconstruct a distal dorsal defect of the great toe, with minimal morbidity at the donor site.

Results The flap initially showed mild congestion but survived completely.

Conclusions Applying a lateral toe pulp flap is a quick, simple, and reliable 1-stage procedure. It may be an effective option in reconstructing distal dorsal defects of the great toe.

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Buddhist Tzu-Chi General Hospital, School of Medicine, Tzu-Chi University, Hualien, Taiwan.

Received September 19, 2018, and accepted for publication, after revision September 21, 2018.

Conflicts of interest and sources of funding: none declared.

Reprints: Li-Fu Cheng, MD, Division of Plastic and Reconstructive Surgery, Department of Surgery, Buddhist Tzu-Chi General Hospital, School of Medicine, Tzu-Chi University, 707, Sec 3, Chung-Yang Rd, Hualien, 970, Taiwan. E-mail: e54978@ms6.hinet.net.

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